Eleanor Roosevelt, 1958

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Wednesday, 14 September 2011

Speaking truth to power

The House of Commons Health Select Committee (HSC) have published a report (also here in pdf form) on their annual accountability hearing with the Care Quality Commission (CQC).  You may recall that earlier this year the HSC gave the CQC rather a grilling over the massive drop off in inspections (which I've discussed previously on this blog).

The report heavily criticises CQC's leadership for the fall-off in inspections, recruitment of inspectors, the 'Excellence' award, their whistleblowing procedures, over-reliance on Quality and Risk Profiles etc, but the reasons it gives for doing so are quite interesting politically.  On scanning through the report the overwhelming impression is of an organisation that was given an impossible task on impossibly tight resources.  From the one-third cut in funds when the three predecessor commissions were combined, to the government-imposed freeze on recruitment of non-front line staff (apparently inspectors are 'back office'), to being required to re-register all providers and a whole bunch of new services on these limited resources, it seems as if CQC were asked to achieve the impossible by parliament and the government.  The report acknowledges that, and yet it still slams the CQC's leadership for failings.  Why?  Because:

'The CQC should have identified the difficulties inherent in the regulations early in the registration process and made clear to the Government that unless modifications were made it would not be able adequately to fulfil its duty to monitor and inspect providers. The senior leadership of the organisation had a responsibility to communicate this to the Government persuasively and persistently.' [21]
In essence, parliament is complaining that CQC were not honest and upfront that they could not deliver on the impossible.  In short, they did not have the balls to confront parliament and the government with the problems they had been dumped with.

The report also refuses to endorse CQC's call for more resources without further information:
We note the CQC’s request for an additional 10% of resources to fund its inspection regime. We already have concerns about the way the CQC has handled and prioritised its existing resources and do not believe that additional resources will address these concerns unless they are deployed as part of a clear strategy. We would therefore welcome a breakdown from the CQC of how it arrived at the figure of 10% and exactly how it would intend to deploy these resources. [29]
I do hope that CQC will provide them with this information and the increase in resources will go ahead - although I am personally doubtful that a 10% increase will be sufficient.  I have asked CQC for more detailed information on expenditure and inspection rates, and hopefully they'll be able to get that to me soon.

In my last post on CQC I wrote:
In some respects I feel sorry for Williams and other CQC managers in all this. I hardly think one could be appointed to the upper ranks of the CQC or its predecessor Commissions singing the unpopular tune that good regulation costs money. They are in danger of becoming scapegoats for a political culture that does not want to pay the price of good care; and so others will pay the price of poorly regulated care.
It does feel as if Williams and Bower have been well and truly shafted.  First of all they are asked to achieve the impossible by parliament, and then they are rebuked by parliament for not doing it.  Perhaps they feared they would be blamed for failing "to do less with more", or their own suitability for the position would be called into question if they admitted they were failing.  It's hard to see how they could - as individuals - have won really; but the outcome has been that everybody - from CQC, to service users - has lost.  Parliament meanwhile seems keen to wash its hands of responsibility by claiming not to have been informed about the problems, when it was clear to everyone in the sector that the situation was desperate.

In their recent review of the regulatory model (which I wrote about on Monday) the CQC considered whether to 'use its position to challenge government policy or highlight risks to the quality of services'.  This report strikes me as a ringing endorsement - from parliament - of greater honesty and upfrontness about risks to services and regulatory standards.  I do find it interesting to conjecture what this report will lead to - a regulator that is more honest about the state of care and their own limited means, a regulator that holds governments to account for the impact of their policies, a regulator that speaks truth to power?

More reading

The response of the CQC to the HSC report can be found here.  They respond to organisational issues like the inspection drop-off, recruitment of inspectors, etc, but not the charge that they were not upfront about their limitations.  The chair (Williams) will be responding in more detail to the committee.

Steven Dorrell - chair of the HSC - has said to Community Care magazine that
“When an organisation is under a statutory obligation to do something, what it cannot be held responsible for is the circumstances it finds itself in."
"The CQC was in a position where it was not going to be able to fulfil its responsibilities, but it didn’t make government aware of this soon enough.”
The Guardian, The Telegraph, The Independent and the Daily Mail have also run articles on the HSC report.


  1. Thanks Lucy. CQC has indeed been humiliated, it will be interesting to see how they now respond.

  2. You are indeed correct. It seems to me that policy decisions overtook the relative speed of reality and the old adage about 'failing to prepare' walked past waving a big banner.